Fsa 2001 Form – Fill Out and Use This PDF

This form is available electronically.		Form Approved – OMB No. 0560-0237
FSA-2001	U.S. DEPARTMENT OF AGRICULTURE	Position 3

(03-06-15)	Farm Service Agency
	REQUEST FOR DIRECT LOAN ASSISTANCE

INSTRUCTIONS: FSA suggests applicants use the available corresponding instructions found on the internet at http://tinyurl.com/kwm5rem for the proper completion of this form. Assistance is also available from local FSA offices for any part of the application process. FSA can provide assistance in completing requested forms, explain what information is necessary, and answer any questions regarding the application process.

Farm Loan Teams located at USDA Service Centers or FSA County Offices are responsible for all direct loan applications. You can find the address and telephone number of the nearest Farm Loan Team serving the County where you plan to farm from the Internet at http://tinyurl.com/7syle36.

The Federal Government requests race, ethnicity and gender information to monitor FSA’s compliance with Federal laws prohibiting discrimination against applicants. Applicants are encouraged to furnish this information. This information is not used to evaluate an application and choosing not to provide this information will not affect the application process.

Targeted funding is available to any member of a targeted underserved group. Targeted underserved groups include American Indians or Alaskan Natives, Asians, Blacks or African Americans, Native Hawaiians or other Pacific Islanders, Hispanics, and Women. Targeted funding may not be received if an applicant fails to voluntarily provide race, ethnicity and gender information.

IMPORTANT NOTICE

Within 10 calendars days of the date FSA receives your application, FSA will send you a letter that will tell you if your application is complete, or additional information is needed to complete your loan application. Incomplete applications cannot be processed. If you do not receive this letter within 10 days of the submission of your application, please contact your local FSA office.

APPLICANT IDENTIFICATION

The loan application must be submitted in the name of the ACTUAL OPERATOR of the farm or ranch.

An individual who operates as a legal entity, or two or more applicants operating and applying jointly, are considered an ENTITY applicant.

Married persons are considered joint operations if the day-to-day management and operation responsibilities of the farm enterprise are shared. Married couples who wish to apply together and have not formed an operating entity such as a partnership, LLC, trust or corporation, are to proceed as designated below. Married couples who have formed a legal entity as part of the farm or ranch should complete this application as an entity applicant.

The Applicant is a/an:

∙Individual, Not Married, Not Operating as a Legal Entity. BEGIN at PART A.

∙Individual, Operating as a Legal Entity. BEGIN at PART C.

∙Married Couple, One Spouse Applying. BEGIN at PART A.

∙Married Couple, Applying Jointly, Not a Legal Entity. BEGIN at PART B.

∙Joint Operation, Two or More Persons, Not Married, Not a Legal Entity. BEGIN at PART C.

∙Entity Applicant. BEGIN at PART C.

NOTE: Entity Applicants are required to provide supporting documentation such as, and not necessarily limited to, Articles of Incorporation; Articles of Organization; Certificate of Limited Partnership; Formal Partnership Agreement; By-Laws and Operational Authorities of all shareholders, members and owners to verify the legal status of the entity, the authority of the shareholders, members or owners, and the composition of the entity structure(s).

PLEASE KEEP THIS PAGE FOR YOUR RECORDS

	FSA-2001 (03-06-15)				Page 5 of 8
	PART D – GENERAL INFORMATION
	1. Counties Being Farmed		2.	Acres Owned
			3.	Acres Rented
	4A.	Purpose of Loan	4B.		Amount Requested
					$
	5A.	Purpose of Loan	5B.		Amount Requested
					$
	6. Description of Operation

PROCEED TO PART E

PART E – NOTIFICATIONS, CERTIFICATIONS AND ACKNOWLEDGMENT

YES

NO

1.Are you currently or have you ever, and in the case of an entity any member of the entity, conducted business under any other name? If "YES," list names in Item 9.

2.Have you ever, or in the case of an entity any member of the entity, obtained a direct or guaranteed farm loan from FSA or Farmers Home Administration?

3.If Item 2 is "YES," did you receive any debt forgiveness through write-down, write-off, compromise, adjustment, reduction, charge-off, paying a loss on a guarantee, or bankruptcy? If "YES," provide details in Item 9.

4.Are you, or in the case of an entity any member of the entity, delinquent on any Federal debt or have any outstanding Federal judgments? If "YES," provide details in Item 9.

5.Are you, or in the case of an entity any member of the entity, involved in any pending litigation? If "YES," provide details in Item 9.

6.Have you, or in the case of an entity any member of the entity, ever been in receivership, discharged in bankruptcy, or filed a petition for reorganization in bankruptcy? If "YES," provide details in Item 9.

7.Are you, or in the case of an entity any member of the entity, an FSA employee or related to or closely associated with an FSA employee? If "YES," provide details in Item 9.

8.Are you now or have you ever, operated a farm? If "YES," provide number of years and details in Item 9.

9.Additional answers. Write the Item number to which each answer applies. If you need additional space, use sheets of paper the same size as this page and write the applicant's name on each additional sheet.

Initials:Date:

	FSA-2001 (03-06-15)	Page 6 of 8
	PART E – NOTIFICATIONS, CERTIFICATIONS AND ACKNOWLEDGMENT (Continued)

10. SPECIAL PROGRAM INFORMATION.

Certain FSA programs are, by law, designed to reach targeted applicants. If you are interested in any of the programs described here, or have questions about these programs and whether you may qualify for a specific program, the FSA office processing your application will help you.

A.SOCIALLY DISADVANTAGED APPLICANTS: A portion of FSA farm ownership, operating, and conservation loan funds are, by law, targeted to applicants who have been subjected to racial, ethnic or gender prejudice because of their identity as a member of a group, without regard to individual qualities. Under the applicable law, groups meeting this condition are: American Indians/Alaskan Natives, Asians, Blacks or African Americans, Native Hawaiians/Other Pacific Islanders, Hispanics and women. In addition, FSA has a down payment program, which receives special funding.

B.BEGINNING FARMER ASSISTANCE: FSA has the authority to assist beginning farmers through the farm ownership, operating, and conservation loan programs. A portion of FSA farm ownership, operating, and conservation loan funds are, by law, targeted to beginning farmers. In addition, FSA has a down payment program, which receives special funding. In some States, FSA has agreements with State beginning farmer programs to help meet the credit needs of beginning farmers.

C. LIMITED RESOURCE LOANS: Limited resource farm ownership and operating loans are available to qualified applicants. This program provides loans at reduced interest rates to low-income farmers whose operations and resources are so limited that they cannot pay the regular rates for FSA loans. The program is also intended to provide beginning farmers the opportunity to start a successful farming operation.

11.RIGHTS AND POLICIES.

A.RIGHT TO FINANCIAL PRIVACY ACT OF 1978 (PUBLIC LAW 95-630): FSA has a right of access to financial records held by financial institutions in connection with providing assistance to you as well as collecting on loans made to you or guaranteed by the Government. Financial records involving your transaction will be available to FSA without further notice or authorization but will not be disclosed or released by this institution to another Government Agency or Department without your consent except as required by law.

B.THE FEDERAL EQUAL CREDIT OPPORTUNITY ACT: Prohibits creditors from discriminating against applicants on the basis of race, color, religion, sex, national origin, marital status, age (provided the applicant has the capacity to enter into a binding contract), because all or a part of the applicant's income derives from any public assistance program, or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act.

C.FEDERAL COLLECTION POLICIES: Delinquencies, defaults, foreclosures and abuses of loans involving programs of the Federal Government can be costly and detrimental to your credit, now and in the future. The lender in this transaction, its agents and assigns as well as the Federal Government, its agencies, agents and assigns, are authorized to take any and all of the following actions in the event loan payments become delinquent: (1) Report your name and account information to a credit bureau; (2) Assess additional interest and penalty charges for the period of time that payment is not made; (3) Assess charges to cover additional administrative costs incurred by the Government to service your account; (4) Offset amounts owed to you under other Federal programs; (5) Refer your account to a private attorney, collection agency or mortgage servicing agency to collect the amount due, foreclose the mortgage, sell the property and seek judgment against you for any deficiency; (6) Refer your account to the Department of Justice for litigation; (7) Take action to offset your salary, or retirement benefits; (8) Refer your debt to the Department of the Treasury for cross-servicing and offset against any amount owed to you by any Federal Agency such as an income tax refund; and (9) Report any resulting written-off debt to the Internal Revenue Service as taxable income. All of these actions can and will be used to recover debts owed to the Federal Government when in its best interests.

12.RESTRICTIONS AND DISCLOSURE OF LOBBYING ACTIVITIES: A. The applicant:

(1)Certifies that if any funds, by or on behalf of the applicant, have been or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant or Federal loan, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, or loan, the applicant shall complete and submit Standard Form - LLL, "Dis closure of Lobbying Activities," in accordance with its instructions.

Initials:Date:

	FSA-2001 (03-06-15)	Page 7 of 8
	PART E – NOTIFICATIONS, CERTIFICATIONS AND ACKNOWLEDGMENT (Continued)

RESTRICTIONS AND DISCLOSURE OF LOBBYING ACTIVITIES:(CONTINUED)

(2)Shall require that the language of this certification be included in the award documents for all sub-awards at all tiers (including contracts, subcontracts, and subgrants, under grants and loans) and that all subrecipients shall certify and disclose accordingly.

B.This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this statement is a prerequisite for making or entering into this transaction. Any person who fails to file the required statement shall be subject to a civil penalty imposed by 31 U.S.C. 1352.

13.CONTROLLED SUBSTANCES:

The applicant certifies that as an individual, or any member of an entity applicant, has not been convicted under Federal or State law of planting, cultivating, growing, producing, harvesting, or storing a controlled substance within the previous 5 crop years. See the Food Security Act of 1985 (Public Law 99-198). The applicant also certifies that as an individual, or any member of an entity applicant, is not ineligible for Federal benefits based on a conviction for the distribution of controlled substances or any offense involving the possession of a controlled substance under 21 U.S.C. § 862.

14.DISQUALIFICATION DUE TO FEDERAL CROP INSURANCE FRAUD:

The applicant certifies that as an individual or any member of the entity, has not been disqualified for Federal benefits as provided in Section 515(h) of the Federal Crop Insurance Act (FCIA). Applicants who willfully and intentionally provide fals e or inaccurate information to the Federal Crop Insurance Corporation (FCIC) or to an approved insurance provider with respect to a policy or plan of FCIC insurance, after notice and an opportunity for a hearing on the record, will be subject to one or more of the sanctions described in section 515(h)(3) of FCIA.

15.TEST FOR CREDIT:

The applicant certifies that the needed credit, with or without a loan guarantee, cannot be obtained by (1) the individual applicant; (2) in the case of an entity, considering all assets owned by the entity and all of the individual members. The provisions of this paragraph do not apply if the request is for a Conservation Loan.

16.PERMISSION TO FILE FINANCING STATEMENT:

Under the Uniform Commercial Code, you do not have to sign the financing statement which allows FSA to obtain a security interest in your property. If the loan is approved and funded, FSA will file a financing statement at the earliest possible date, before you enter into a SECURITY AGREEMENT. BY SIGNING BELOW, I GIVE FSA PERMISSION TO FILE A

FINANCING STATEMENT PRIOR TO THE EXECUTION OF THE SECURITY AGREEMENT AS WELL AS TO FILE AMENDMENTS AND CONTINUATIONS OF THE FINANCING STATEMENT THEREAFTER.

PROCEED TO PART F

Initials:Date: